The Budget Scalpel and Medical Research

WASHINGTON — President Barack Obama’s call for “investments” in education, infrastructure and science and health research is dismissed by most congressional Republicans as a fig leaf for more big-government spending.

That underlies the House of Representatives’ decision Saturday to slash $61 billion from an array of discretionary spending programs in the current fiscal year budget.

This may make proponents feel good, yet, as almost all budget experts acknowledge, these measures have little to do with addressing America’s fiscal challenges. That would require focusing on entitlements, taxes and defense spending.

If all domestic discretionary spending, about 12 percent of the budget, were eliminated — no Department of Education, no F.B.I. agents, no air-traffic controllers — there still would be a deficit of more than $1 trillion this year.

And some of the cuts entail risks.

These include slicing foreign aid even as China is expanding its assistance and influence; cutting the staffing at the Securities and Exchange Commission when it has new regulations to enforce and is striving to thwart the next Bernard Madoff; and reducing nutritional support for low-income pregnant women and their babies, which demonstrably reduces future health care costs.

There is no more telling illustration than the National Institutes of Health, the center of U.S. medical research and the largest such institution in world. House Republicans want to cut N.I.H. funding for the current year by more than $1 billion, to $29.5 billion. Mr. Obama, meanwhile, proposes increasing N.I.H. funding next year 2.4 percent, to $31.8 billion.

While this 5 percent reduction is less severe than other proposals in the Republican budget, it reverses a 15-year bipartisan effort to support medical research. The N.I.H. budget has almost tripled over the last decade and a half.

This was achieved with considerable support from Republicans like John Porter, who served for 21 years as a congressman from Illinois.

“America’s economic destiny depends upon maintaining and enhancing our lead in technology, innovation, science and research,” says Mr. Porter, now chairman of Research America, an advocacy group in Alexandria, Virginia.

He is horrified by what House Republicans want to do to N.I.H. “These are blind cuts that take us exactly in the wrong direction; they are wrong-headed and short-sighted,” he said.

Representative Paul Ryan, the chairman of the House Budget Committee, demurs when asked about N.I.H. cuts; a spokesman for the Wisconsin Republican says the agency has received substantial funding increases in recent years, that the Democrats’ “spending spree” must stop and that priorities need to be set.

With the economy as a priority, says the legendary investor Peter Lynch, health-research spending should be at the top of the agenda. “The N.I.H. has been one of the great elements of our economy,” said Mr. Lynch, who managed Fidelity’s Magellan Fund from 1977 to 1990, when assets grew 630-fold. “We should be expanding, not reducing this investment.”

If funding were doubled over seven years for most government programs or agencies — like the Pentagon or health or housing projects — there would be enormous inefficiencies and fraud as they tried to absorb such a rapid escalation. Almost every serious analysis says N.I.H. did this without these abuses. More than 70 percent of its budget is devoted to peer-reviewed research grants, of which only about one in five qualified applications are approved. For every dollar of public funding for scientific research, the drug industry gets a $3 return, according to one study.

And the progress in battling disease, especially in recent years, has been noteworthy, with the United States leading the way. Heart disease and deaths from strokes are decreasing. In 2007, cancer deaths declined for the first time. Much of this is owed to the N.I.H.

“N.I.H.-funded research has revolutionized how we think about cancer,” Francis Collins, the agency’s director, has said, noting that much treatment has gone from reactive to proactive.

Representative Ed Markey, a Massachusetts Democrat, made an impassioned plea on the House floor last week to restore this funding, warning of subsequent health care costs if research is slowed in areas like Alzheimer’s. The Markey proposal was ruled out of order on procedural grounds.

House Republicans tend to duck if asked about cutting research for cancer or Alzheimer’s or Parkinson’s. Yet it would be very difficult to cut 5 percent from the N.I.H. budget without taking some from the $5.1 billion received by the National Institute on Cancer, or the $1.1 billion for the National Institute on Aging, or the $1.96 billion for the National Institute of Diabetes and Digestive and Kidney Diseases.

Future advances in areas like brain science are especially threatened.

N.I.H. research is “absolutely indispensable” to breakthroughs in neuroscience, said Guy McKhann, the founding director of the Mind/Brain Institute at Johns Hopkins University and the former chairman of the department of neurology at the university’s medical school.

Dr. McKhann, who once worked at the N.I.H., says that young researchers would be most affected by any cuts. “They have excellent training and are ready to start serious research on their own, but there’s not enough money and there’s already pressure for them to go into private practice; there is no replacing them,” he said.

Mr. Lynch says that if there are cutbacks, these young researchers will have an option that “endangers” America’s lead in this economically critical area: They can go to places like Singapore and China, which are ambitiously expanding health research.

The House action reflects the breakdown of bipartisan support for battling diseases that know no political boundaries. The N.I.H. commands near-universal respect, as does Dr. Collins, its director. He led the Human Genome Project and has been called one of the most accomplished scientists of our time.

This is only the first volley in the budget wars; the Senate, with Republican support, is likely to restore most of the N.I.H. cuts. If Congress subsequently deals with the real deficit issues — contrary to conventional wisdom, a “grand bargain” involving entitlement cuts and tax increases may evolve — the meat-ax approach to medical research can be taken off the table.